LASIK Self Evaluation Test

What is your age group?

Without my glasses and contacts. Check all that apply

What do you usually wear? Check all that apply

Do you have any of the following?

Rate this statement on a scale of 1-5 with 1 being the lowest: "I would like to see well at a distance without relying on glasses or contact lenses."

Rate this statement on a scale of 1-5 with 1 being the lowest: "I would like to see well up close without relying on glasses or contact lenses."

Would your career or business activities improve if you were to become less dependent on glasses and contacts?

If you are a candidate, how soon would you like to improve your vision?

How did you hear about LASIK at Shepard Eye Center